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FOR OFFICE USE: <br /> ...... ........ ...... ................. ....... Is-.2 <br /> APPLICATION FOR SANITATION PERMIT Permit No. .-...---.--..._..-.-. <br /> ----------- - -------------------- <br /> .............. ...... . ...... .. .. - --------------- (Complete in Duplicate) Date Issued <br /> .1- ---- --------- This Permit Expires 1 Year From Date Issued <br /> Aft ........... . ...... <br /> NwApplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS A D LOCATI�O�{,&r...... ...... <br /> Owners Name_ . <br /> .............. Phone....-..--. ..... ..........-....... <br /> .. <br /> Address.......... .......... <br /> L 13 U. C.114 JjE=�---------------- <br /> ._E�......A.U.4;... .......01V,6.,*-- .Ma W� <br /> ........ Phone.................-.............- <br /> Contractor's .....6-15PT!C. .....4S�Kq.�V��. --------- <br /> Installation will some: Residentis [B"'Aparfmant House [I Commercial Q Trailer Court [I Motel 0 other [I <br /> . of living units: 1P Number of bodroonT :-'7--Number of 42. 1 V�!��60,!size _-----A'- -.rEA&4;�--------------- <br /> Number if..... 14�1 <br /> Water Supply: Public system P Community system F1 Private gr Depth TO Water Table J.5. ft. <br /> Character of soil to a depth of'3 fee+: Send (Gravel [] Sandy Loam [Clay Loam 0 1'Clay [I Adobe[I Hardpan 0 <br /> Previous Application Made: (I�Fes date----- - -----------.) No [�/New Construction: Yes 2?"No 0 FHA/VA: Yes D No <br /> ECIFICA-k-M.- <br /> TYPE 00 INSTALLATION -AND SP 'T 0 S: <br /> A <br /> (No septic +ank or cesspool permitted if public sewer, is available wodfn 200 feet.) <br /> Septic Tank: Distance film nearest well.................Distance from foundation--------------------Material-------....................................... <br /> J�'K)Sn AJ(�, No. of con1partments..........................size....-------------/---......Liquid clepth..................------Capacity---------------------- <br /> Disposal Field: Distances from nearest well.... Distance-fr94-foundatim..................Distance to nearest lot line-.-.-...-.-_.._ <br /> Number . <br /> 4of lines- .. <br /> ................ .......... .... ngth of each line......-)----------- ...Width of trench.-...._..-:..-..._..------------- <br /> Type of 4ille'r material.............. ........ )epth.6f filter rnaferial-J...................Total length....----------------------------........ <br /> Seepage Pit: Distance�al ' <br /> nearest well------ 5...... DisfanCe from foundatJ--- ...D;stanc to nearest lot line---- <br /> Num r f pifs.......... L f grial-kc-Y ....Size: iameter..3-'A--- ------Depth......IV................ 7 <br /> Number I ------- MMI -t` <br /> • <br /> Cesspool: Distanclifrn nearest we -------- 'istance from foundatic Lining material-._._.-_--...._._.-.......-....... <br /> ❑ Size: Diem t ................. ........ Liquid Capacity........ .........gals. <br /> rest wei E------r. <br /> Privy: Distanceef in nee ... ---- .................. A.-.Dofanie from nearest building._.._..__._..._.................. <br /> ❑ DistanceTto nearest [of [in ------- ........ .................. -----I .......................-------------------.................. <br /> 4 : A - <br /> r be). ............................................... <br /> Remodeling and/or repairing esc i ................... ................. ....... <br /> 'j- <br /> -------------- ------ _----f2,-x-'------------------------ ..............--......--...... <br /> ...................-............. <br /> ---------- ............ ------- ----.....I ...... <br /> ..................... <br /> I her a b y �er t j4y +IT a f I haveepar d A* lieati(� and that the W at <br /> ................. <br /> ..........Aua--L. ::: � <br /> i'will a done in accordano Twifh Santeoaquin County <br /> a pip <br /> Ordinance$, Si it laws, a n&Qru aln)dgr ula '0' of the San Joaquin Local HealfA District. ult <br /> lv� t < <br /> ......... ----L(�wner analor Contracto <br /> V <br /> Y., ----------- .. .................4TIfle)............. ............... ..... ................ <br /> By:_...-.-.. <br /> y:....-......... ....................... <br /> ------------- -- ----------- <br /> (Plot plan. showing Size of lot, 14cation of sysfam in 61afian to wells, buildings, etC., can be placed an reverse side). <br /> lotcation <br /> is I Ild — <br /> I , I 'F(jR DEPARTMENT USE ONLYAPPLICATION ACCEPTED BY!---.-.{-_..r- .............................11-1---------�....... DATE-.._.L..... <br /> REVIEWEDBY---- ............................... ...................-............................... ........... DATE---....-----------------------........... .......... <br /> BUILDING-PERMtT-ISS-U-- <br /> Aheratione end/or ;;ca­rmmna­na-&'fions:---------- ........ -------- •",---.....-....---,.-..--'------...----------"............ <br /> rA -A <br /> ..........................—.................... ..................---------........:............ ...... ....... -1-...........................-.................................. <br /> .... ................._.1.-.....---..............M....................-................. ................................------------------------------------------------------------................ <br /> ...vl� ...........................................................-........................... <br /> ........... <br /> ------------------ ................... ------ --------- ----- ............. ..................... .............................I..........--------------- <br /> -7 QP <br /> • FINAONSP ...... ... Date........ ........... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT.............. <br /> 130 South American-Stispatt 300 West Oak Snow 124 Sycarsom Street 203 West 9th Shoe <br /> Stockton,Callfis.--r.A Lodi,California Manteca,California TrcKy,Califarrila <br /> ES 9 REVISED 8.59 2M 5-62 ATLAS <br />